Efficacy of Pre-emptive Infiltration of Dexmedetomidine with a Local Anaesthetic on Postoperative Pain in Maxillofacial Trauma Management under General Anaesthesia: A Prospective Study.

Introduction: Pre-emptive analgesia aims to reduce post-operative pain and the need for analgesics. Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist with sedative and analgesic properties. The aim of this study was to compare the effectiveness of pre-emptive infiltration of DEX combined with local anaesthetic (2% lignocaine with adrenaline) in managing post-operative pain in maxillofacial trauma patients undergoing open reduction and internal fixation procedures, as compared to pre-emptive infiltration of placebo (saline) with the same local anaesthetic. Materials and Methods: Forty-two participants of maxillofacial trauma with a Visual Analogue Scale (VAS) score of more than 4 were included in this double-blinded randomised controlled trial. Group DL (Dexmedetomidine with local anaesthetic) received dexmedetomidine (DEX) with local anaesthesia while group PL (placebo with local anaesthetic) received placebo with local anaesthesia. Participants were evaluated for the time taken for the first rescue analgesic, total doses of fentanyl taken by the patient in the first 24 h, post-operative pain (VAS) at 6, 12, 16 and 24 h, post-operative side effects and analysed. Results: The DL group had a significantly longer time to first rescue analgesic compared to the PL group. Surgeons in the DL group reported higher satisfaction and better surgical field visibility. Post-operative VAS scores were lower in the DL group at 6 and 12 h, with a median score of 1 at 16 and 24 h. Discussion: Pre-emptive DEX infiltration is effective in reducing post-operative pain and opioid consumption in maxillofacial trauma cases undergoing open reduction and internal fixation. This approach can enhance patient comfort and improve surgical outcomes without significant risks.

Gorlin-Goltz Syndrome: A Case Series.

Gorlin-Goltz syndrome (GGS) among Indians is rarely reported. Since 1960, only 38 cases having 48 patients of Gorlin-Goltz syndrome have been identified in the Indian population. It is crucial to diagnose this illness early because it can be connected to a malignant lesion like fibrosarcoma, leiomyosarcoma or rhabdomyosarcoma. The four patients in this case series were identified and treated in our department between 2019 and 2023. The average patient age was around 20 years old. Jaw swelling and tooth movement were the two most typical presenting concerns. Odontogenic keratocysts (100%), palmer pits (100%), plantar pits (50%), calcification of falx cerebri (50%), and rib abnormalities (50%), were the most prevalent characteristics. None of the patients had basal cell cancer, cleft lip, or medulloblastoma. Multiple odontogenic keratocysts were present in three cases, whereas a single odontogenic keratocyst (OKC) was seen in one patient. Patients were managed with either marsupialization or enucleation, depending on the size of the cyst. Two cases with a large cyst size were marsupialized by using a modified obturator. Two cases with small cysts were managed with enucleation of the cyst followed by chemical cauterization. Recurrence was seen in two cases. In one patient, we noticed the formation of a new cyst. A GGS diagnosis can be made by having a systemic evaluation of the patient. A thorough examination of the patient should be performed in every histopathology-diagnosed case of OKC. This will help to miss the syndromic cases. The treatment part should be conservative, like marsupialization with an obturator in a large cyst. The obturator helps maintain patient hygiene and prevents regular visits for changing dressings. Small-sized cysts can be managed with enucleation and chemical cauterization. Radical resection should be avoided.

Pleomorphic Adenoma of the Palate With an Atypical Malignant Presentation: A Case Report.

A pleomorphic adenoma is a mixed salivary gland tumor. The parotid gland is the most common site. The intraoral palate is the most common site due to the abundance of accessory salivary glands in the palatal area. It has a very slow growth rate and is usually painless. Consequently, patients often have a lengthy history of presentation. Herein, we report a case of pleomorphic adenoma of the palate in a 53-year-old male patient. The mass was 5 cm by 4 cm in size. The growth rate was rapid, and it attained a large size in just nine months. On clinical examination, the overlying mucosa was ulcerated. On general examination, lymphadenopathy of the right side level 1 b lymph node was found. These clinical findings were consistent with malignancy. However, the histopathological report negated the clinical findings of malignant salivary gland tumors. The tumor was managed with a wide local excision of the tumor with a 1 cm clear margin. The postoperative course was uneventful. No recurrence was seen after two years of follow-up. A thorough cytological or histological examination is a prerequisite to defining the malignant nature of the lesion.

Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study.

Introduction: Sclerosing agents have been used for temporomandibular joint (TMJ) hypermobility since decades, some of which are ethanolamine oleate, and OK-432, sodium psylliate (sylnasol), but there are no studies on the usage of polidocanol - a well-known sclerosing agent which does not have much side effects and is inexpensive. Hence, this study evaluates the effect of polidocanol injection in the treatment of TMJ hypermobility. Methodology: This was a prospective observational study in which patients with chronic TMJ hypermobility were included. Out of the 44 patients who had symptoms of clicking and pain of the TMJ, 28 were diagnosed as internal derangement of the TMJ. The final analysis included 15 patients in whom multiple injections of polidocanol were given on the basis of post-operative parameters. The sample size was calculated based on a significance level of 0.05 and a power of 80%. Results: Overall, a success rate of 86.6% (13/15) was encountered at the end of three months, with seven patients not reporting any further episodes of dislocation after one injection and six patients not reporting any episode of dislocation after two injections. Discussion: Polidocanol sclerotherapy can be used as a treatment modality for chronic recurrent dislocation of the TMJ, rather than opting for more invasive procedures for the same.